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BACKGROUND: To advance rehabilitation we need a comprehensive understanding of functioning and disability of people after stroke. OBJECTIVE: To present an overview of the methodology of the Life After Stroke In Northern Sweden Study, compare participants and non-participants regarding gender and age, and describe baseline sociodemographics, stroke characteristics and the participants' self-rated degree of recovery. METHODS: Data were collected through a study specific questionnaire, from the participants' medical records and with internationally established self-assessment tools focusing on sleep disturbances, depressive symptoms, fatigue, physical activity, and remaining physical and cognitive impairments, activity limitations, participation restrictions and life satisfaction. RESULTS: Of 301 potential participants, 160 comprise the final sample (response rate 53%; 86 men and 74 women, mean age 73 years±11, mean time since stroke onset 35 months±11; 18– 61). Most participants had an ischemic stroke (87%), were retired (84%), cohabitant (63%) and walked independently (71%). The mean self-rated degree of recovery was 75 (SD±24; 0– 100). CONCLUSIONS: These baseline data together with forthcoming studies will describe stroke-related impairments, activity limitations, participation restrictions and life satisfaction more than one year after stroke, and deepen our understanding of factors of importance for a healthy and successful life after stroke. [ABSTRACT FROM AUTHOR]

Functional outcomes in autism spectrum disorder can be highly variable given the heterogeneous nature of autism spectrum disorder and its interaction with environmental factors. We set out to compare parent/caregiver perceptions of functioning in two divergent countries that participated in the International Classification of Functioning Disability and Health (ICF) Core Set for Autism Spectrum Disorder development study. We focused on the frequency and content of items reported, and hypothesized that environmental factors would most frequently be reported as barriers to functioning in low-resource settings. Using frequency and qualitative content analysis, we compared data from South Africa (n = 22) and Sweden (n = 13). Frequency agreement was seen in three activities and participation categories, and one environmental factor. Obvious frequency differences were observed in one environmental factors category, six body functions categories and three activities and participation categories. Only three ICF categories (immediate family, attention functions, products and technology for personal use) differed in content. Contrary to our hypotheses, few differences in perspectives about environmental factors emerged. The universality of our findings supports the global usefulness of the recently developed ICF Core Sets for Autism Spectrum Disorder. We recommend that more comparative studies on autism spectrum disorder and functioning should be conducted, and that similar comparisons in other disorders where Core Sets have been developed may be valuable. [ABSTRACT FROM AUTHOR]

Purpose:To describe activity in different aspects of daily life among long-term stroke survivors, and conceptualise the content of the Barthel Index (BI) and the Swedish extended and modified Frenchay Activities Index (mFAI) using the ICF framework. Method:Assessments were performed by means of the BI and the mFAI at a 10-year follow-up of 145 consecutive stroke survivors from Lund Stroke Register, Sweden. After linking the two instruments to the ICF core set for stroke, data were analysed and presented in terms of activity-specific domain-scores for the total sample and sub-groups according to gender and age. Results:Together the two instruments covered 69% of the Activities and participation component of the ICF core set for stroke. Two activity-specific domains were identified within the BI and six within the mFAI. Most participants reported a high overall activity level. Inactivity was most common among those ≥80 years. Men and women participated in different types of activities and used different modes of transport. Conclusions:Long-term stroke survivors have a high activity level in daily life, though individual variation is considerable. The structure provided by linking instruments to the ICF core set for stroke can be used for more fine-tuned descriptions of activity.Implications for RehabilitationSince most long-term stroke survivors are independent in ADL but may have limitations in other activity domains such as social and leisure activities, these aspects should be considered in the rehabilitation process.Older stroke survivors deserve special attention due to their higher risk of long-term inactivity.The Barthel Index and the Swedish extended and modified Frenchay Activities Index are complementary for assessments of ADL and social activity after stroke and cover over two thirds of the Activities and participation component in the ICF core set for stroke. [ABSTRACT FROM AUTHOR]

Aim: In Sweden, the information in the sickness certificate is crucially important for the sick-listed person as well as for the Swedish Social Insurance Agency and the sick-listed person’s employer. The certificate is used as the basis for deciding whether a person is entitled to sickness benefits. Further, it communicates information significant for the return-to-work process. The aim of the study was to evaluate the quality of sickness certificates issued in primary health care and examine if the patients’ or physicians’ gender influences the information in the sickness certificate. Methods: An insurance specialist at the Swedish Social Insurance Agency assessed the quality of the stated information in a sample of 323 certificates issued by 146 different general practitioners at 29 different primary health care centres in northern Sweden. Results: Thirty-four percent of the certificates did not contain sufficient information requested. The areas of the certificates in need of supplementary information were mainly the descriptions of impairment of body function and activity limitation. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was more often prescribed for male patients than for female. Significant differences between certificates issued for women and certificates issued for men appeared in the group of musculoskeletal diseases. No differences in quality aspects connected to physicians’ gender were found. Conclusion: Our study indicates a need for increased knowledge about the descriptions of functioning for sick-listed persons; more cooperation between health professionals in primary health care and a better gender awareness in health care encounters. [ABSTRACT FROM AUTHOR]

Background: Long-term sickness absence is high in many Western countries. In Sweden and many other countries, decisions on entitlement to sickness benefits and return to work measures are based on information provided by physicians in sickness certificates. The quality demands, as stressed by the Swedish sick leave guidelines from 2008, included accurate sickness certificates with assessment of functioning clearly documented. This study aims to compare quality of sickness certificates between 2007 and 2009 in Östergötland County, Sweden. Quality is defined in terms of descriptions of functioning with the use of activity and participation according to WHO's International Classification of Functioning, Disability and Health (ICF), and in prescriptions of early rehabilitation. Methods: During two weeks in 2007 and four weeks in 2009, all certificates had been collected upon arrival to the social insurance office in Östergötland County, Sweden. Four hundred seventy-five new certificates were included in 2007 and 501 in 2009. Prolongations of sick leave were included until the last date of sick listing. Free text on functioning was analysed deductively using the ICF framework, and placed into categories (body functions/ structures, activity, participation, no description) for statistical analysis. Results: The majority of the certificates were issued for musculoskeletal diseases or mental disorders. Text on functioning could be classified into the components of ICF in 65% and 78% of sickness certificates issued in 2007 and 2009, respectively. Descriptions according to body components such as "sensations of pain" or "emotional functions" were given in 58% of the certificates from 2007 and in 65% from 2009. The activity component, for example "walking" or "handling stress", was more frequent in certificates issued in 2009 compared with 2007 (33% versus 26%). Prescriptions of early rehabilitation increased from 27% in 2007 to 35% in 2009, primarily due to more counseling. Conclusions: An improvement of the quality between certificates collected in 2007 and 2009 was demonstrated in Östergötland County, Sweden. The certificates from 2009 provided more information linkable to ICF and incorporated an increased use of activity limitations when describing patients' functioning. Still, activity limitations and prescriptions of early rehabilitation were only present in one-third of the sickness certificates. [ABSTRACT FROM AUTHOR]

Aims: Sickness certificates are to provide information on a disease and its consequences on the patient’s functioning. This information has implications for the patient’s rights to sickness benefits and return-to-work measures. The objective of this study was to investigate the description of functioning in sickness certificates according to WHO’s International Classification of Functioning, Disability, and Health (ICF), and to describe the influence of patients’ age, gender, diagnostic group, and affiliation of certifying physician. Method: A content analysis of written statements regarding how the disease limits the patient’s functioning with ICF as a framework was performed in 475 sickness certificates, consecutively collected in Östergötland County, Sweden. Results: Musculoskeletal diseases (MSD) were the largest diagnostic group, followed by mental disorders (MD). Certificates were mainly issued from physicians at hospitals and in primary health care (PHC). ICF was applicable for classifying statements regarding functioning in 311 certificates (65%). The distribution of components was 58% body functions, 26% activity, and 7% participation. The descriptions were primarily restricted to the use of at least one component; namely, body functions. Subgroup analysis showed that descriptions of activity and participation were more common in certificates for MD and MSD, or those issued by PHC physicians. A multiple regression analysis with the activity component as dependent variable confirmed the results by showing that activity was related to both diagnosis and affiliation. Conclusions: In a consecutive sample of sickness certificates, it was shown that information on functioning is scarce. When functioning was described, it was mainly body oriented. [ABSTRACT FROM PUBLISHER]

This study approaches inclusive schools by looking at how conditions for participation are expressed for pupils with additional support needs in education policy documents in Sweden and Scotland. By using five dimensions of the environment - availability, accessibility, affordability, accommodability and acceptability - expressions of conditions for participation are explored in 41 documents. This is done in a vertical manner by analysing national laws, regional policy documents, and local-level documents that directly influence classroom practices. A deductive content analysis approach using a protocol based on the five environmental dimensions is used to extract information and identify meaning units. In the meaning units, meaningful concepts are identified and linked to International Classification of Functioning, Disability and Health: Child and Youth (ICF-CY) categories. These are used as reference points. It is suggested, from the documents analysed, that conditions for participation are easy to express as available, accessible opportunities, or affordability issues, but not as involvement experiences linked to accommodations made and acceptability issues within a context. Documents in Scotland and Sweden also have different foci in terms of conditions for participation. [ABSTRACT FROM AUTHOR]